James Harrison, who spent more than 20 years working at Brandywine Counseling and Community Services in Wilmington, used to see three or four people die of hepatitis C every month. Hepatitis C is a blood-borne virus that causes inflammation of the liver and can lead to liver failure.
A former intravenous drug user, he himself had been infected with the virus 30 years ago and underwent regular testing to monitor its damage. In 1999, he endured eight months of the only treatment known at the time, accompanied by debilitating side effects, only to find it hadn’t worked.
So earlier this year, when he was told he was in Stage 4 – the worst – of cirrhosis of the liver, he anxiously turned for help to the infectious disease clinic located in Brandywine Counseling and run by the Christiana Care HIV Program. There he hoped he would be able to access new blockbuster drugs capable of wiping out the disease.
He was in luck. In the past, the HIV Program offered treatment for hepatitis C, but usually only for patients who also were infected with the virus that causes AIDS. But when Harrison arrived, the clinic had quietly begun to expand its Hepatitis C treatment.
In April, Harrison completed the three-month treatment and has been cured of the virus.
“I got a new lease on life,” said Harrison, who would write inspirational messages on the pill bottles as he emptied them. On the last one, he penned: “Praise God. This is done.”
William Mazur, M.D., an infectious disease specialist with the HIV Program at Christiana Care, said that as new, highly effective drugs have become available in the past few years, and Delaware residents have exhibited a growing desire for them, it was a natural step to expand treatment beyond HIV-infected patients.
“It was very organic how things came together, and at the right time,” Dr. Mazur said.
Dr. Mazur splits his time between the HIV Program, based at Wilmington Hospital, and the Delaware Department of Corrections, where he often sees inmates infected with hepatitis C.
“It was always challenging when a person was leaving the prison system to figure out where to send them for treatment,” he said.
Now, he can continue to see them at Christiana Care, at one of eight sites statewide.
“There has always been an interface between the two epidemics,” – HIV and hepatitis C — said Arlene Bincsik, RN, MS, CCRC, ACRN, director of the HIV Program, which was created in 1989 and currently serves 1,800 patients.
Christiana Care’s HIV patients always have been tested for the hepatitis C virus, she said, and the co-infection rate is about 28 percent.
Meanwhile, according to Harrison, slightly more than half of those treated at Brandywine Counseling test positive for the virus. An IV drug user is likely to contract hepatitis C within 18 months of beginning to shoot up, he said.
Until about two years ago, however, few opted to be treated for hepatitis C because the regimen was long, success rates were poor and the physical and psychological side effects were extreme.
Over a 10-year period, about 25 patients underwent the previous therapy at Christiana Care – and fewer than half were cured, said Susan Szabo, M.D., medical director of the HIV Program. In the past two years, 55 co-infected patients have been treated.
Dr. Mazur brought in the first hepatitis C patient not infected with HIV for treatment in February 2014. Since then, about 25 more have been treated.
The parallels between HIV and hepatitis C treatment made expanding the program a natural progression, Szabo said.
The routes of transmission are similar. The viruses tend to disproportionately affect a disenfranchised population. HIV and hepatitis C patients benefit from a multidisciplinary infrastructure that includes social workers who can assess family support and transportation needs, mental health counseling and actual treatment.
“Our existing care model lends itself to this type of service,” Dr. Mazur said.
Explained Bincsik, “We take care of people in a very comprehensive way.”
For both diseases, the drugs have evolved over time to become extremely effective.
Referring to the evolution of hepatitis C drugs, Dr. Mazur said, “It’s happened shockingly fast and will continue to change at a rapid pace.”
The biggest barrier to treatment is the cost: A full regimen of the current drugs used to treat hepatitis C can run from $75,000 to $150,000, depending on a person’s genotype, Dr. Mazur said. Medicaid and health insurance programs generally will approve it only for the sickest patients.
Much of the HIV Program’s work, therefore, is spent at the front end, getting the treatments pre-approved, Bincsik said.
The expansion of treatment to non-HIV patients aligns with Christiana Care’s commitment to community health, she said.
“Treatment is prevention,” she said. “Studies show that the more people who are in treatment and reach viral suppression, the fewer the new cases in the community.”
It is unclear how many people in Delaware are infected with hepatitis C, because the Delaware Division of Public Health does not report the statistics. Nationwide, however, new cases of hepatitis C increased 151.5 percent from 2010 to 2013, according to the Centers for Disease Control and Prevention.
Bincsik said the HIV Program is not trying to compete with the private sector in offering hepatitis C treatment, but aiming to identify patients who might otherwise not be able to get the drugs. This involves outreach at Brandywine Counseling, Westside Family Healthcare and elsewhere. Christiana Care also has a program called Project Engage, whose counselors check in with people admitted to the hospital for reasons related to substance abuse.
It hasn’t been hard to find new patients, she said. “They’re finding us.”